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TOPLINE:

High‑risk patients with newly diagnosed atrial fibrillation (AF) who underwent catheter ablation within 1 year of diagnosis had lower risks for major adverse cardiovascular events (MACEs), heart failure, and all-cause mortality than those who did not undergo ablation.

METHODOLOGY:

• Researchers emulated a target trial to evaluate whether early catheter ablation helped mitigate the risk for MACEs in high-risk patients newly diagnosed with AF.
• They identified 263,329 adult patients with first-time AF between January 2015 and April 2022 from the TriNetX electronic health record network. All patients had a high risk for stroke according to a standard scoring system.
• A total of 2018 patients (0.8%) underwent catheter ablation within 365 days of AF diagnosis and were propensity score-matched with control patients who did not undergo ablation. Each matched group had 2018 patients (mean ages, 65.57 and 65.26, respectively; 62.3% men in both groups).
• The primary outcome was the occurrence of MACEs, defined as a composite of acute coronary syndrome, ischemic stroke, hemorrhagic stroke, and death. Secondary outcomes included heart failure and all‑cause mortality.
• Researchers started outcome follow-up on day 366 after AF diagnosis for 1 year and conducted a sensitivity analysis extending the duration to 2 years.

TAKEAWAY:

• MACEs occurred less often in patients who underwent catheter ablation than in those who did not (2.1% vs 5.0%), corresponding to a 58% relative reduction in the risk (log-rank P < .001).
• Patients who underwent ablation had lower risks for heart failure (hazard ratio [HR], 0.627; 95% CI, 0.494-0.797) and all-cause mortality (HR, 0.182; 95% CI, 0.092-0.357) than control patients.
• In the 2-year sensitivity analysis, ablation remained associated with reduced risks for MACEs, heart failure, and all-cause mortality.
• Prespecified subgroup analyses found a consistent association between ablation and a reduced risk for MACEs across age, sex, and baseline medication use, with no significant within-subgroup interactions.

IN PRACTICE:

“In this population-based study using a TTE design, early catheter ablation in high-risk patients with newly diagnosed AF was associated with a lower risk of MACE and heart failure. These findings provide additional observational evidence on early catheter ablation,” the researchers of the study wrote.

SOURCE:

The study was led by Chi-Che Ho, of Chi Mei Medical Center in Tainan, Taiwan. It was published online on May 8 in Heart.

LIMITATIONS:

The observational design could not rule out unmeasured confounding. Relying on electronic health data and diagnostic codes may have introduced the risk for misclassification and underreporting of outcomes. The follow-up duration was relatively short.

DISCLOSURES:

The authors did not declare any specific funding source or competing interests related to the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.